Provider Demographics
NPI:1477659449
Name:EVAN H. GEISSLER, D.O., LTD.
Entity Type:Organization
Organization Name:EVAN H. GEISSLER, D.O., LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:GEISSLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:219-931-4725
Mailing Address - Street 1:7134 CALUMET AVE
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46324-2406
Mailing Address - Country:US
Mailing Address - Phone:219-931-4725
Mailing Address - Fax:219-932-4028
Practice Address - Street 1:7134 CALUMET AVE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46324-2406
Practice Address - Country:US
Practice Address - Phone:219-931-4725
Practice Address - Fax:219-932-4028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02000568A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN408790Medicare ID - Type Unspecified
INC25023Medicare UPIN